Borderline Personality Disorder: The Battlefield of Stigma

In my career as a researcher, I have heard the phrases “BPD patients are a hassle” and “don’t touch borderline with a bargepole”. They’re throwaway remarks, but they often are said from the mouths of people who I would otherwise describe as intelligent and deeply empathetic.

As a researcher at King’s with roots in community mental health projects, documentary filmmaking and getting to the end of a sudoku and realising I’ve made a mistake a long time ago, I’m used to asking why.

So, why do people feel so strongly about BPD?

Borderline Personality Disorder (BPD) has been considered to be one of the most stigmatised of all mental illnesses . You don’t need to look very hard in society, or in clinical settings, to find a plethora of negative attitudes, beliefs and discrimination towards those with the diagnosis.  

To a layman, maybe this stigma seems warranted. After all, the terms ‘borderline’ and ‘personality disorder’ sound scary. Dangerous, even.

However, neither term accurately describes the condition. The idea that people with BPD exist on the “borderline” between psychosis and neurosis has been outdated, dating back to its original definition by psychoanalyst Adolph Stern in 1938. More recently, many have argued BPD is closer to a mood disorder or trauma-based response than anything to do with ‘personality’. 

That leaves us with a disorder with the wrong name and wrong classification. If changing the name alone would lead to progress, stigma would have disappeared when we started using ‘Emotionally Unstable Personality Disorder’ as an alternative. Sadly, misleading terminology is merely a scratch among many deep wounds. The cycle is already at full speed; the horse has bolted far away and those with BPD are facing catastrophic consequences.

People with BPD are estimated to have a suicide risk 45 times higher than that of the general population, with 1 in 10 dying by suicide and 75% attempting within their lifetime. Notably, while self-injurious behaviours and suicide attempts can be core features of BPD; this relationship is likely to be complex, with stigma potentially playing an important role. For BPD, stigma is present in both health and crisis care services, and these experiences can make help-seeking and service utilisation feel distressing or invalidating, potentially creating further barriers for effective support. In this sense, if poor outcomes for those with BPD are a burning building, stigma is an entire road of gridlocked traffic in the way of the fire engines bringing water.

Beyond metaphors, most people with BPD have life-changing experiences of stigma. I have gathered these from personal interviews and online forums to present in this article, which will detail a typical post-diagnostic journey. These experiences have happened to a range of people with BPD, but I want to acknowledge that some people receive support and have better care outcomes. Someone described fighting stigma as a battlefield, “you need to be in armour”, so I’ve also illustrated the stages after diagnosis as the story of a brave knight. (I’m allowed to have some metaphors; it helps lighten the mood).

THIS BRAVE KNIGHT WAS TOLD TO BE BRAVE AS THE SWORD HIT THEIR SHOULDER.

At your appointment, the psychiatrist tells you they won’t put the BPD diagnosis into your record, because of the stigma. They tell you the illness should get better in 4 years with treatment, but there’s no treatment in your borough because the waiting list is too long.

THIS BRAVE KNIGHT HEARD THE TICK OF THE CLOCK RING ACROSS THEIR BRAIN AS TIME PASSED.

You go home and start to research BPD. You resonate with the symptoms:All emotions felt at 100%, a fear of abandonment that makes you cling to those close to you and spiral into panic when they don’t reply. Chronic emptiness, dissociation, patterns of difficult relationships, impulsive behaviour, self-harm and suicide attempts.

THIS BRAVE KNIGHT POLISHED THEIR ARMOUR, WAITING FOR THE STIGMA BEAST TO PICK OUT THEIR SCENT.

You go to the GP and ask for help. Some might offer medications for when you are in crisis, others tell you that you have no medication or treatment options, that your defect doesn’t fit their model of care. Your tears, in response to this, are thought to be calculated. Besides, the GP thinks you are not unwell enough.

THIS BRAVE KNIGHT FOUND THE BEAST IN A&E AFTER A ROGUE SPEAR HAD PIERCED THROUGH A BREAK IN THEIR ARMOUR.

You become more unwell. An episode of self-harm sends you to A&E where a nurse is actually very nice to you. You tell them your diagnosis, and they immediately stop dressing the wound and move away. They tell you to go back into the waiting room, you’re exhibiting attention-seeking behaviour. You ask for help dressing the wound. They put their equipment to one side and go to get you a single plaster. They tell you to put it on yourself.

THIS BRAVE KNIGHT SEARCHED FOR SHELTER AMONG THE ROCKS, THE MOSS AND THE BODIES.

You try again and again over 6 years to access any support. As you become more unwell, you become more desperate and present more extremely. One service makes the same wrong treatment referral three times and each time it feels as though your life depends on it. One service discharges you after you become too risky. You walk around with an infected gall bladder because A&E didn’t believe you were in pain. You are too unwell, not unwell enough, treatment resistant, a burden on services, deceitful, unsalvageable. You wonder if their plan is to wait for you to die and free up a space for services.

THIS BRAVE KNIGHT SENT PIGEONS BEARING NEWS TO THOSE AT HOME, UNAWARE OF THE BEAST’S CLAWS ALREADY WITHIN.

At work, the phone keeps ringing continuously, and your colleague describes it as a “BPD phone” because it is “overreacting,” going off nonstop. You start to laugh because it’s so ridiculous. Your tenacity has grown in the dark, without the help of treatment. You find support in some friends and family and gradually start to get better, although you worry how things would have turned out if you didn’t have their support.

THIS BRAVE KNIGHT SAW THE FUNERAL PROCESSIONS AND JOINED, STEPS HEAVY BUT DETERMINED.

You watch members of the BPD community fall after being rejected from services. You attend their funerals, write evidence for their inquests and remember they weren’t borderline – their personalities were warm, funny, creative, stubborn, loyal and determined. You vow to make sure that nobody else is forced to survive this battlefield.

I jump at any opportunity to write about BPD to keep that vow, because life after a diagnosis really is this tragic, difficult and extreme for most people, and it was after my BPD diagnosis too. It may have been obvious from my abstract rantings was diagnosed with BPD ten years ago.  I am lucky to describe myself as recovered now; thanks to the support I received from friends and family. However, I am still recovering from the memories of the stigma I faced when unwell. I didn’t introduce myself with my diagnosis because I want you now to think about whether that affects how you see me or the legitimacy of these stories. It shouldn’t change your opinion at all.

Although some people with BPD do manage to access support, a catch-all solution to the vicious cycle of neglect faced by many of those diagnosed feels out of reach. It’s not as if you can run into a policy-maker’s office, jump on a table and scream out the words from this article (unless you can, in which case you have my permission to). Instead, I suspect change is, instead, a series of smaller brave moments, such as challenging the next time you hear someone say, “BPD patients are a hassle” or “that’s a BPD phone.”

Such as in the experiences of ‘This Brave Knight’, I hope that these small moments brought together can prompt reflection, reconsideration and change. It is vital that they do.

Image credit: Luce Stewart, This Brave Knight I-VII, 2025, pen on paper